Provider Demographics
NPI:1386897304
Name:FERTEL, DOREEN H (MA OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:H
Last Name:FERTEL
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:MISS
Other - First Name:DOREEN
Other - Middle Name:H
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA OTR/L
Mailing Address - Street 1:1022 78TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2612
Mailing Address - Country:US
Mailing Address - Phone:718-745-5922
Mailing Address - Fax:
Practice Address - Street 1:1022 78TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2612
Practice Address - Country:US
Practice Address - Phone:718-745-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004203-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ78911OtherEMPIRE BLUE CROSS BLUE SHIELD